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September 19, 2001

Insulin Analogs

Question from La Mesa, California, USA:

My 41 year old wife just got switched over from NPH and R to Lantus and lispro. She happened to go into the nurse practitioner on Tuesday when all the terrorist stuff was going on. Needless to say, both she and the nurse practitioner were a bit distracted, and the pharmacy did not have too much info for her. It sounds like not too many people are on this program yet. Is it still in experimental phase? Please help with any and all information for her regarding what to expect, transition time for her body to adjust, etc.


From: DTeam Staff

Lantus (insulin glargine) has been available in the US for about four months, commercially available in Germany for over a year, and been used in a variety of research protocols for the past four or so years around the world. So, overall experience is increasing with lots of interest from the diabetes community since it theoretically provides a better basal insulin profile, much like the basal insulin effect of the insulin pump.

It is used as a multi-dose intensified insulin regimen in which bolus insulin is provided usually with one of the insulin analogs (Humalog or Novolog) before meals and the Lantus for overnight and basal effect. Learning to use it must be individual since there are a great many variations of how it could be used — alone at bedtime is the usually starting place, but some folks might need a morning and an evening Lantus dose, some need a small dose of NPH at breakfast while others need a small dose of NPH at lunchtime. All with boluses of analog pre-meals and pre-snacks.

The more blood glucose readings that are done, the more pre- and postprandial as well as overnight testing, the better to be able to fine tune and individually adjust this new regimen.

Remember that no other insulin can be mixed in the same syringes as Lantus because of pH differences and incompatibility of the diluents. Also remember that it is a long-acting insulin and so one must wait a few days after a dose change to see if the change has worked or needs further adjustments.

Your wife should stay in close contact with her diabetes team as she is making such changes, keep lots of records, look at plotted graphs or download from the meter to a computer to identify patterns requiring further adjustments.